Clinical Territory Manager, Diabetes
Medtronic
Medical/Clinical Policy Writer
CareSource
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $70,800 - $113,200 per year
Job Level
JuniorMid-Level
About the role
- Medical/Clinical Policy Writer research and develop moderate to complex Medical/Clinical, BH, and Reimbursement policies; ensure adherence to company, state, and federal guidelines.
- Support the operational processes of the Policy Governance Committee
- Monitor status reports to ensure effective workflow and timely development of medical and pharmacy policies
- Support internal departments and processes in the development and implementation of policies and procedures
- Ensure all medical policies are compliant with relevant regulations and are consistent across all lines of business
- Participate in department initiatives and projects
- Research clinical and scientific literature and consensus guidelines to create work products for team input and to inform CPC
- Create and update policy bibliographies
- Work with health plan business product leaders, specialty companies, and corporate leaders to develop deliverables on policy priorities
- Provide medical/clinical, BH, and reimbursement policies policy deliverables for Medicare, Medicaid, MyCare, D-SNP, Marketplace products and other markets as business needs change
- Coordinate with subject matter experts to develop policy on issues that impact CareSource from medical/clinical, BH, and reimbursement policies policy perspectives
- Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies
- Collaborate with interdisciplinary team members to achieve team goals
- Knowledge of NCQA policy timely requirements
- Perform any other job duties as requested
Requirements
- Bachelor’s degree or equivalent years of relevant work experience is required
- Advanced degree or equivalent education/degree in life sciences/healthcare is preferred
- Minimum of two (2) years of healthcare-related writing experience preferred; clinical and managed care backgrounds preferred
- Minimum of two (2) years of experience in medical policy development and/or implementation preferred
- Strong presentation skills
- Computer skills/proficiency level with Microsoft Word, Excel, search engines, and bibliographic software
- Knowledge of medical terminology and claims payment policies
- Strong clinical expertise and healthcare administration understanding
- Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature
- Ability to interpret complex clinical information and apply to policy development
- Excellent verbal and written communications skills
- Presentation and decision-making skills
- Excellent organization and tracking skills
- Good problem-solving skills
- Ability to interface with employees at all levels
- Ability to handle multiple priorities/projects simultaneously
- RN or equivalent clinical licensure preferred, or in lieu of licensure: 2 years Clinical /Medical policy writing experience or equivalent
- Policy/Healthcare experience
